Nothing’s scarier in a psychiatric hospital than seeing a patient who was brought in by police officers with his hands handcuffed behind his back. My hospital has a separate psychiatric emergency department that is located away from the rest of the hospital. For whatever reason, please officers often arrest violent individuals and then bring them in for us to deal with. Usually, I’m pretty confident interviewing one of our attempted murderer guests when they’ve been drugged up on Ativan and tied to a bed. Last week police officers Baker Acted a 250-pound antisocial gentleman who was stopping Hispanics and violently demanding that they show him their papers. The officers brought the man to the psychiatric hospital, took off the handcuffs, and left him alone to be interviewed by me.

I went through the regular interview and noticed that the patient was becoming more and more agitated. In these situations, we are supposed to immediately end the interview and leave the room. When I was trying to walk out on this particular patient, he decided to charge after me. I quickly tried to close the door lock the patient in this room, be forced the door opened before I could get my key into the slot. He tried to take one swing at me, but by that time a police officer who just happened to be walking through the hall pulled out his Taser and yelled, “If you take one more step forward I’m going to shoot you!” The patient backed down, the nurses restrained him, and we gave him a nice shot of Haldol and Ativan to chemically control him.

I had hoped that the hospital had learned a lesson about restraining patients before interviewing them. You can imagine my surprise then, when my last patient of the day produced as his only form of identification a card that read “Corrections Inmate.”

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REO SpeedDealersaid,

I did inpatient psych at a facility that was the city’s exclusive hospital for the corrections system. My compadres and I used to carry what we called a 5-2-1. 5 mg Haldol, 2 mg Ativan, 1 mg Cogentin. When a patient went bat-fuck insane, standard operating procedure was to produce said syringe and hope to hell you manage to inject it into him before he kills you. It worked pretty well. Nobody on my rotation got more than a pretty harmless sucker punch before the Vitamin-H kicked in.

Half M.D.: At my hospital, only nurses give out 5-2’s. I wonder why the medical students can’t carry Haldol and Ativan. Or better yet, give us all tasers. They have a lot fewer side-effects than medication, and they work instantly.

Rsaid,

I’m a premed student who works at a psychiatric hospital as a nurse aide… You are just so negative about psychiatry! I’m not really sure where to start. First of all, using restraints preemptively is a horrible idea – it makes patients unmanageable for days. They lose all trust in the hospital and won’t take their meds, irritate other patients with their negative behaviors, etc. Also, it’s very obvious that you are terrified of the patients. I know they’re scary. I’ve been stabbed at with various things, smothered with pillows, swung at, cussed at and threatened multiple times. But, you can’t let them know that you are scared! Unless the patient is completely off in lala land they usually won’t attack you if you treat them like a human being. When you act terrified they know you don’t see them as a person, just as a possible threat. When you expect them to be a decent person they often do. Of course I don’t know the specifics of this situation, but from reading all of your psych posts, I get the feeling that people like YOU are the reason medical students can’t carry around Haldol.